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“It was personal. It was now. It was the future.” The mental health toll of climate disasters

The critical need for the Australian Government to put climate health on the agenda was clear from a powerful session on the mental health toll of bushfires and climate change at last week’s annual Congress of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in Hobart.

The conference coincided with the launch of a new International Energy Agency report, Net Zero by 2050: A Roadmap for the Global Energy Sector, warning that we are approaching a decisive moment for international efforts to tackle the climate crisis, but with huge health dividends if we act.

The report highlights the massive health benefits from tackling carbon emissions and air pollution, estimating the potential for lower inside and outside air pollution to roughly halve premature deaths in 2050 compared with 2020, “saving the lives of about 2 million people per year, around 85% of them in emerging market and developing economies”.

Croakey journalist Dr Amy Coopes reports on the #RANZCP2021 session below for the Croakey Conference News Service. You can bookmark the series here.


Amy Coopes writes:

As the climate emergency advances and intensifies, bringing ecological grief and existential angst about human survival, Australian and New Zealand psychiatrists have been warned the mental health of coming generations will be tested as never before by the cumulative and rolling impacts of disasters.

These effects will include post-traumatic stress disorder, depression, anxiety, substance use and explosive anger leading to family and domestic violence, and social cohesion will be central to staving off the worst of its effects, the annual Congress of the Royal Australian and New Zealand Psychiatrists (RANZCP) was told last week in Hobart.

The unparalleled 2019-20 Australian bushfire crisis and precipitating climate emergency were the focus of a closing symposium at the conference, which is among the first major medical specialty meetings to be held in Australia since the eruption of the coronavirus pandemic.

The lessons of previous Australian disasters including longitudinal findings from survivors of the 2009 Black Saturday bushfires in Victoria were discussed, along with reflections from the frontlines of last summer’s fire emergency.

With these sorts of events expected to increase both in frequency and intensity over coming decades, understanding and anticipating the mental health impacts would be essential to both preparedness and recovery, the session heard.


Cumulative and compounding events

Dr Murray Wright, chief psychiatrist of New South Wales, offered a glimpse behind the scenes of the State Government’s response to the 2019-20 bushfires, a national crisis which claimed 33 lives, destroyed more than 3,000 homes and shrouded Australia for months in a pall of toxic smoke.

Wright said the emergency was unprecedented in a number of ways. First was its sheer scale, impacting almost half the state’s local health districts and lasting for many months – with the first fires igniting in September 2019, and the final blaze not extinguished until the following March – and communities shifting along the spectrum to recovery at their own speed in that time.

Perhaps more important, and a harbinger of what we could expect in an era of climate crisis, was that New South Wales was already in disaster mode when the fires hit, grappling with the worst drought in living memory – with many of the same communities affected.

Rather than the typical emotional trajectory of a disaster, Wright said these cumulative and compounding events had seen a “staccato decline in function” for affected populations. From the outset, he said it was obvious which communities would struggle most, with social cohesion a key predictor of risk.

For the government, the scale and length of the crisis – involving an unprecedented three successive state of emergency declarations in November and December 2019 and January 2020 – posed new challenges around deployment of mental health response crews including where they were drawn from and how long they were dispatched for, Wright said. These groups swiftly went from being seen as heroes on the ground to becoming targets of anger at governments, and Wright said there were also safety and access questions for response crews as the fires burned on in some areas for many weeks and months.

One of the key lessons Wright said had been drawn from last summer’s events was that psychological first aid training was essential for every single person involved in disaster response, from frontline workers up.

“Because the levels of community distress we experienced were everywhere, and everyone,” Wright told the symposium. “The whole of the South Coast was traumatised.”

In an era of increasing disasters, Wright said the government was also considering formation of a volunteer corps, like the NSW Rural Fire Service (RFS), of mental health respondents, drawn from private practice and retired psychiatrists, and establishment of permanent recovery clinicians in rural and regional areas.


Impact of subsequent life stressors

Drawing on data from the Beyond Bushfires longitudinal study of Black Saturday survivors, David Forbes, from the Phoenix Australia Centre for Posttraumatic Mental Health, took delegates through some of the mental health and associated impacts of disaster.

Not everyone responded the same to a crisis, Forbes said, and this was determined by factors preceding, linked to, and following the event.

The Beyond Bushfires study demonstrated a link between intensity of the original disaster impact and later mental health ‘case-ness’ for things like PTSD, anxiety/depression and substance use in the ensuing three to four years, with rates of 26 per cent in the worst-affected communities, 17 per cent in moderately impacted areas and 12% in low-impact zones.

Problematic anger and its sequelae, including hostile aggressive behaviour (13-fold increase in worst-affected areas), and suicidal ideation (8-fold increase), were also linked to disaster intensity. Anger translated directly into increased family and domestic violence, with 7.4 per cent of women in the worst-affected communities reporting experiencing violence in the 12 months after Black Saturday, Forbes said, an “extremely worrying” phenomenon.

However, Forbes said subsequent life stressors, particularly threats to financial and housing security, determined “above and beyond” the original impact, whether people went on to experience adverse mental health effects. This highlighted the importance of long-term financial and other forms of support to mitigate mental health effects, he said.

Ten years after Black Saturday, Forbes said levels of PTSD dropped off but depression and substance use was unchanged. In the worst-affected areas, 10 years on, he said 22 per cent of people were still experiencing PTSD, depression or severe distress, and this was associated with extent of original property loss, and subsequent traumas or stressful life events. Only a quarter had sought professional help in the preceding six months.

“When we’re talking about climate change, we’re talking about trauma on trauma on trauma, and what we see in this dataset is, over the course of ten years, these factors accrue,” Forbes told the forum.

Though the study had not specifically examined the impact of COVID-19, as it had occurred outside the research period, Forbes said it had been a confounder to recovery, undermining social cohesion through fear, uncertainty and perceptions of risk as well as via government-mandated distancing and isolation.


Heightened existential angst

Children and young people had been among groups whose mental health was worst affected by the pandemic, with data presented earlier at the Congress showing a rise in youth crisis presentations to emergency departments and increasing eating disorders.

They were also the group likely to be most vulnerable to adverse psychological impacts of the climate crisis, the session heard.

Eminent Australian child psychiatrist Dr Brett McDermott shared his experiences across several decades working in Australia and elsewhere with young disaster survivors.

He said there was “palpable” child and adolescent angst about the climate crisis and, as it accelerated, bringing more frequent and overlapping acute single-event traumas, this ‘heightened existential angst’ would leave a whole generation more vulnerable to adverse mental health impacts.

He condemned a “perfect storm” of politically-controlled media coverage and government inaction for downplaying “strong grassroots angst” in the community about the climate emergency.

In the final presentation of the day, psychiatrist-psychotherapist Dr Charles Le Feuvre, who is executive director of the non-profit Psychology for a Safe Climate, discussed his work on eco-distress. It has involved counselling those “who have grieved over loss of land to drought, who grieved over the loss of so many beings in the bushfires; those who fear rising sea levels and diminishing ice, and those who fear human extinction”.

He described the 2019-20 bushfire crisis as a ‘double trauma’, razing huge tracts of Australia and cloaking the nation in a smoke haze that was “a global memorial to humans, other living beings and places we loved but had lost.”

“It was a global fire alarm for a climate emergency,” Le Feuvre said.

While many people had accepted the reality of climate change, he said there was widespread denial of its implications – megafires, extreme weather events, mass migration, conflict and social collapse –  with people instead retreating into a bubble of apathy. “The fear and grief can be overwhelming when this bubble bursts,” he said.

Le Feuvre described a growing sense in the community of ecological grief for a “loss of species, ecosystems and meaningful landscapes”, and eco-anxiety, “watching slow and seemingly irrevocable impacts unfold and worrying about the future”.

He said children and young people were particularly vulnerable to these feelings, with a sense of powerlessness and apathy, entrenched through decades of political intransigence, resulting in profound angst with no outlet.

A shared sense of purpose – hope emerging through the process of engagement and action – was one way to combat these. He pointed to the value for mental health of engaging in the school strikes for climate and urging “strong, realistic yet compassionate leadership” from those in power to provide “moral direction in the face of uncertainty and insecurity”.

Read a 55-tweet summary thread of the session here.

#RANZCP2021 was held from May 16-20 in Hobart. Read the rest of our coverage here.

The feature image for this article is an artwork by Elizabeth Gleeson, a Program Collaboration Coordinator at the Climate Council, who participated in a workshop conducted by RANZCP Congress presenter Dr Charles Le Feuvre, executive director of the non-profit Psychology for a Safe Climate. Participants were asked to produce a piece of art that illustrated their feelings, in the wake of the devastating 2019-20 bushfires and with the constant stream of information on the climate crisis in their work.


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